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Anosognosia and Alzheimer’s Disease: More Than Denial

Sarah Stevenson
By Sarah StevensonJune 16, 2020

Anosognosia is more than just denial. This condition often affects Alzheimer’s patients, impairing their ability to understand or perceive that they’re ill.

Anosognosia can be a complex condition. It may vary over time. A person may clearly understand their condition one moment and show complete lack of awareness in another. This fluctuation may make you think your elderly loved one is in denial about their cognitive impairment. But people who have anosognosia are truly unaware that they have a medical condition that requires treatment.

Understanding anosognosia and how it affects those with Alzheimer’s disease can help you empathize with your senior relative who has a cognitive impairment. It can also help you plan for the best care for your loved one and find strategies to help them get the treatment they need.

What is anosognosia?

Anosognosia is a medical condition that’s often defined as a lack of insight. People who have anosognosia are unaware that they have a cognitive impairment. Anosognosia is most common in individuals with schizophrenia or bipolar disorder, but it also often affects people with Alzheimer’s disease.

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If your loved one has anosognosia, they may minimize their symptoms or provide explanations for concerns you bring up as a caregiver. They may also refuse treatment.

However, anosognosia is not static — its symptoms may come and go. Your relative may sometimes be agreeable and comply with treatment, but they may completely forget they’re ill on other occasions. In some cases, a person with anosognosia may be aware of some symptoms of their illness and unaware of others.  

Without treatment, symptoms of anosognosia may worsen and hinder your loved one’s ability to perceive their underlying illness. It may be difficult for caregivers and family members to help a loved one with anosognosia get treatment for their underlying illness.

Anosognosia medical definition

Anosognosia is a lack of self-awareness, where someone who has a condition or disability is unaware of having it. One study published in the  Journal of Neurology, Neurosurgery and Psychiatry defines anosognosia as the “inability to identify the presence of the deficits or characteristic of a disease, as well as their magnitude, progression, and how they limit life.”

Anosognosia pronunciation

The proper pronunciation for anosognosia is uh-no-sog-NOH-zee-uh. Anosognosia means “to not know a disease” in Greek: a- (without) + nosos (disease) + gnosis (knowledge). The first documented use of this term was in 1914.

What causes anosognosia?

Anosognosia is difficult to fully understand. Certain neurological and mental health conditions seem to affect the area of the brain called the frontal lobe, which controls memory and a person’s perception of themselves and their health.

Over time, and throughout life, people constantly update how they think of themselves based on different events, such as marriage, a trip abroad, or learning a new skill. In people with anosognosia, the frontal lobe doesn’t work as it should. This means the person isn’t able to update their perception to understand changes that are happening to them or their illness.

Who is affected by anosognosia?

Anosognosia is most commonly associated with schizophrenia and bipolar disorder. However, symptoms of anosognosia are also commonly linked to these other conditions:

Anosognosia and Alzheimer’s disease

Anosognosia is fairly common in people with Alzheimer’s disease. In fact, it’s estimated that up to 81% of people with Alzheimer’s have some form of anosognosia. Symptoms of anosognosia may also worsen as Alzheimer’s disease progresses.

If your loved one has anosognosia, the misperception they experience feels real. Their lack of awareness may lead to conflicts and difficulty getting them to take their medications. Your relative may also feel anxious, act dangerously, and become irritable, agitated, and combative. They may avoid those who confront them.

How is anosognosia diagnosed?

It may be difficult for caregivers to differentiate anosognosia from denial. This is because anosognosia can affect people differently. Your loved one may be entirely unaware of their illness, or they may recognize some symptoms but not others. The degree of their awareness may fluctuate.

If your parent has a condition associated with anosognosia, the doctor may use assessment tools to diagnose it. These tools can help check whether your loved one:

  • Recognizes they have symptoms of a condition
  • Is aware of the social consequences of their symptoms
  • Understands they need treatment for their condition
  • Realizes their symptoms may result from a health condition

How is anosognosia treated?

It’s not easy to treat anosognosia. Treatment is based on the condition that’s causing it. For people who are diagnosed with Alzheimer’s disease but are unaware of their condition, it may help to seek care from a psychiatrist or counselor.

Certain types of therapy, such as motivational enhancement therapy (MET), can help someone take a closer look at their symptoms and behaviors, which may lead to improved awareness. Rather than convincing people with anosognosia of their illness, this type of talk therapy can also help them understand the benefits of changing their behavior, in part by focusing on goals for improved health and quality of life.

How do you help someone with anosognosia?

You may feel frustrated and helpless if you’re caring for a parent with Alzheimer’s who doesn’t know they have it. One way to help a loved one who lives with anosognosia is to use the LEAP method:

  • Let your loved one know you hear what they’re saying
    Reflect back what they said without changing or influencing the meaning of their words.
  • Identify with your loved one’s experience to help them feel understood and respected. This might help your parent feel less defensive and more open to listening to your opinion
  • Find something  you can agree with, and focus on it. Avoid offering your opinion until they ask for it
  • Build trust with your loved one to increase cooperation. You may not agree on the problem, but you can work together to find a solution — because your relationship matters more than logic

This method can help you start a dialogue with your relative without coming across as accusatory or judgmental.

If your loved one has anosognosia and Alzheimer’s, accept that some days will be easier than others. Try to be supportive: Remember that your aging relative isn’t trying to be stubborn or difficult — they truly aren’t aware of their condition and symptoms.

If you notice symptoms of anosognosia, make an appointment to see your relative’s doctor for an assessment. The doctor can recommend treatment and strategies to ensure your relative gets the help they need.

As Alzheimer’s disease progresses, it’s important to prepare for future care needs. Contact our Senior Living Advisors to learn about memory care communities, which specialize in caring for seniors with Alzheimer’s disease, other types of dementia, or other forms of memory loss. These communities offer 24-hour supervision to assist with activities of daily living and help prevent wandering.


Sources:

National Alliance on Mental Illness. “Anosognosia.” https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Anosognosia.

Vannini P., et al. “Anosognosia for memory deficits in mild cognitive impairment: insight into the neural mechanism using functional and molecular imaging. NeuroImage Clinical, 2017: https://www.sciencedirect.com/science/article/pii/S2213158217301262.

Castrillo Sanz A., et al. “Anosognosia in Alzheimer’s disease: prevalence, associated factors, and influence on disease progression.” Neurologia, 2016: https://pubmed.ncbi.nlm.nih.gov/25976940/.

Treatment Advocacy Center. “Anosognosia.” https://www.treatmentadvocacycenter.org/key-issues/anosognosia.

Sarah Stevenson
Author
Sarah Stevenson
(800) 809-0113
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